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Pediatric influenza vaccination in the perioperative setting: A quality improvement project
Andrew J Meyer1, Jill R Smith1, Tara L Wright1
1Akron Children's Hospital, Akron, Ohio, USA.
Insights
Pediatric surgical patients received seasonal influenza vaccinations during preoperative clinic visits, exceeding vaccination rate goals over three seasons. This quality improvement initiative safely integrated vaccination into perioperative care without impacting surgical schedules.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Quality Improvement Science
Background:
- Seasonal influenza vaccination is crucial for pediatric patients, with unmet needs often observed.
- The perioperative period presents a unique opportunity to administer influenza vaccines, addressing access barriers.
- Integrating vaccination into preoperative clinic visits within a pediatric perioperative surgical home (PSH) can improve vaccination rates.
Purpose of the Study:
- To establish and increase the seasonal influenza vaccination rate in eligible pediatric patients during preoperative clinic visits.
- To implement and evaluate a quality improvement initiative targeting perioperative influenza vaccination.
- To assess the feasibility and safety of administering influenza vaccines in a PSH setting.
Main Methods:
- Utilized the Model for Improvement methodology across three influenza seasons.
- Implemented interventions including policy updates, supply procurement, EHR tools, staff education, and patient-family communication.
- Tracked vaccination rates and monitored same-day surgical cancellations as a balancing measure, using statistical process control.
Main Results:
- Achieved and exceeded influenza vaccination rate goals of 10%, 15%, and 18% over three consecutive seasons.
- Administered a total of 695 influenza vaccines since program inception.
- Observed no same-day surgical case cancellations related to perioperative vaccination.
Conclusions:
- Successfully established and met seasonal influenza vaccination rate goals in a pediatric PSH setting.
- Demonstrated the safety and effectiveness of administering influenza vaccines during the perioperative period.
- The perioperative period is a viable opportunity for influenza vaccination, with potential for expansion to other routine childhood vaccines.
Introduction/Background:
Unmet need for seasonal influenza vaccination administration to pediatric patients exists at national and local levels. Vaccination during the perioperative period remains controversial, though opportunity exists to meet vaccination need through perioperative programs. The initial SMART Aim of this quality improvement initiative was to establish and increase seasonal influenza vaccination rate in eligible patients during in person preoperative clinic visits in a pediatric perioperative surgical home (PSH) to 10%. Informed by each prior season's experience, we increased our SMART Aim target for vaccinations in seasons two and three to 15 and 18%, respectively.
Methods:
Following the Model for Improvement methodology, the PSH team developed and implemented a perioperative pediatric influenza vaccination program. Across three influenza seasons, key interventions included updates to organizational perioperative vaccination policy, obtaining material influenza vaccination supplies, development of EHR tools, PSH staff education, and communication with patient-families. Rate of eligible patients receiving influenza vaccination at their PSH clinic appointment was tracked over time. Influenza vaccination rates were reported monthly during Season 1, then weekly during seasons two and three. The balancing measure was same day surgery case cancellations related to influenza vaccination given at PSH clinic appointment. Statistical analysis methods utilized include Shewart's control chart and statistical process control (SPC) standards. Special cause variation was determined by eight or more consecutive data points above or below the centerline.
Results:
The influenza vaccination rates in each of the three influenza seasons exceeded vaccination rate goals of 10, 15, and 18%, respectively. A total of 695 vaccines have been administered since program inception. No same day surgical case cancellations were observed as balancing measure.
Conclusions:
Over three consecutive influenza vaccination seasons, we safely established and met vaccination rate goals of 10, 15, and 18% to eligible patients during preoperative clinic visits within a pediatric PSH system. Through iterative PDSA cycles, we continue to identify opportunities for future improvement. This suggests that the perioperative period presents opportunity for seasonal influenza vaccination with potential program expansion to include routine vaccines of childhood.
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